Diagnosis and Assessment Diagnosis
ÎThe general population of children need not be tested for FA to highly allergenic foods prior to their introduction into the diet. (B-III)
Note: The general population of children does not have pre-existing severe allergic disease and also does not have a family history of FA.
ÎThe health care professional considering a diagnosis of food-induced anaphylaxis should understand: (A-III)
> The signs and symptoms characteristic of anaphylaxis > The timing of symptoms in association with food ingestion/exposure > Comorbid conditions, such as asthma, that may affect treatment and outcome > The limited utility of laboratory parameters in the acute care setting
ÎFA should be considered: (A-II)
> In individuals presenting with anaphylaxis or any combination of symptoms listed in Table 1 that occur within minutes to hours of ingesting food, especially in young children and/or if symptoms have followed the ingestion of a specific food on more than one occasion
> In infants, young children and selected older children diagnosed with certain disorders, such as moderate to severe AD, EoE, enterocolitis, enteropathy, and AP > In adults diagnosed with EoE
ÎUse the medical history and physical examination to aid in the diagnosis of FA. (A-III)
> Medical history: The expert panel (EP) recommends using a detailed medical history to help focus the evaluation of an FA. Although the medical history often provides evidence for the type of food-induced allergic reaction and the potential causative food(s) involved, history alone cannot be considered diagnostic of FA.
> Physical examination: The EP recommends performing a focused physical examination of the patient, which may provide signs consistent with an allergic reaction or disorder often associated with FA. However, by itself, the physical examination cannot be considered diagnostic of FA.
ÎParent and patient reports of FA must be confirmed, because multiple studies demonstrate that 50% to 90% of presumed FAs are not allergies. (A-I)
ÎTo assist in the identification of foods that may be provoking IgE- mediated food-induced allergic reactions, perform:
> a skin puncture test (SPT) (A-II) > allergen-specific IgE (sIgE) tests (A-II) > but NOT intradermal testing (A-III) > and NOT the routine use of measuring total serum IgE (A-III) Note: These tests alone are not diagnostic of FA.
ÎDo NOT use atopy patch test (APT) for the routine evaluation of noncontact FA. (B-III)
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